Provider Demographics
NPI:1053674507
Name:WILSON, ERROL TAVARES
Entity type:Individual
Prefix:MR
First Name:ERROL
Middle Name:TAVARES
Last Name:WILSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1474 REMSEN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4908
Mailing Address - Country:US
Mailing Address - Phone:347-326-1833
Mailing Address - Fax:718-251-7983
Practice Address - Street 1:1474 REMSEN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4908
Practice Address - Country:US
Practice Address - Phone:347-326-1833
Practice Address - Fax:718-251-7983
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist